The governance experience and lessons learned from the mental health service system in the United States

The American mental health service system has evolved over more than a century, resulting in a highly complex and resource-rich governance structure. This paper uses a framework consisting of “governance structure, operational mechanisms, and performance outcomes” to analyze the institutional evolution, organizational operations, and governance effectiveness of this system. In the United States, federal authorities play a leading role, while state governments are responsible for implementation. Multiple providers contribute to the system, with public insurance payments and community service organizations serving as the main delivery channels. However, due to issues such as fragmented funding, weak regulation, and increasing inequality, the system faces the challenge of “high investment, low output.” China should strengthen top-level coordination and legal safeguards, improve mechanisms for medical insurance support and community integration, and promote government-led initiatives along with social participation…